Gliomas near motor pathways are mapped intraoperatively to identify functioning tissue and monitor motor systems. During glioma surgery, the authors reviewed their use of a variety of approaches to map and monitor patients’ motor function. When compared to their earlier methodology of cortical and subcortical bipolar stimulation, they established that their triple motor mapping method was very safe and effective, and that it enhanced outcomes.The authors describe their initial experience identifying, monitoring, and preserving cortical and subcortical motor systems during glioma surgery using all three modalities.

Patient Selection and Characteristics, Anesthetic Protocol, Surgical and Mapping Technique and Imaging. All patients who developed new or exacerbated postoperative motor impairments were tracked for at least six months. Between January 2018 and August 2019, 59 surgeries on 58 patients were conducted. In total, 6 patients (10.2 percent) experienced new or severe early postoperative impairments. After 6 months, only 2 individuals (3.4%) had permanently exacerbated impairments. The placement of the insula was the only factor that predicted lasting impairments (p = 0.046). Triple motor mapping while asleep is safe and results in a low rate of impairments without jeopardising the resection’s extent.Bipolar and monopolar stimulation, along with transcranial and direct cortical MEP monitoring, resulted in enhanced localisation of functional tissue and low rates of transitory and permanent impairments.

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